title: Diarrhea in enterally fed patients: blame the diet?
abstract: OBJECTIVE
  Diarrhea has great impact on enteral nutrition. The purpose of this review is to identify the factors leading to diarrhea during enteral nutrition and to provide the published updates on diarrhea prevention through nutritional intervention.
  
  
  RESULTS
  Diarrhea in enteral fed patients is attributed to multiple factors, including medications (major contributor), infections, bacterial contamination, underlying disease, and enteral feeding. Diet management can alleviate diarrhea in enteral feeding. High content of fermentable oligosaccharides, disaccharides, and monosaccharides and polyols (FODMAPs) in enteral formula is postulated to induce diarrhea and lower FODMAPs formula may reduce the likelihood of diarrhea in enterally fed patients. Fiber-enriched formula can reduce the incidence of diarrhea and produce short-chain fatty acids for colonocytes. Ingesting prebiotics, nonviable probiotics or probiotic derivatives, and human lactoferrin may provide alternatives for reducing/preventing diarrhea.
  
  
  CONCLUSIONS
  Enteral feeding is not generally considered the primary cause of diarrhea, which is frequently linked to prescribed medications. When diarrhea is apparent, healthcare members should evaluate the possible risk factors and systematically attempt to eliminate the underlying causes of diarrhea before reducing or suspending enteral feeding. Lower FODMAPs formula, prebiotics, probiotic derivatives, and lactoferrin may be used to manage enteral feeding-related diarrhea.
authors.affiliation: Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan. sjchang@mail.ncku.edu.tw
authors.forename: Sue-Joan
authors.initials: SJ
authors.lastname: Chang
authors.forename: Hsiu-Hua
authors.initials: HH
authors.lastname: Huang
mesh_terms: D016638:Critical Illness / Q000628:therapy; D003428:Cross Infection / Q000209:etiology / Q000473:pathology; D003967:Diarrhea / Q000209:etiology / Q000517:prevention & control*; D004032:Diet; D004043:Dietary Fiber / Q000008:administration & dosage; D004187:Disaccharides / Q000008:administration & dosage; D004750:Enteral Nutrition / Q000009:adverse effects*; D041981:Gastrointestinal Tract / Q000187:drug effects / Q000382:microbiology; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications / Q000503:physiopathology; D007781:Lactoferrin / Q000008:administration & dosage; D064307:Microbiota; D009005:Monosaccharides / Q000008:administration & dosage; D009844:Oligosaccharides / Q000008:administration & dosage; D056692:Prebiotics / Q000032:analysis; D019936:Probiotics / Q000008:administration & dosage
chemical_list: D004043:Dietary Fiber; D004187:Disaccharides; D009005:Monosaccharides; D009844:Oligosaccharides; D056692:Prebiotics; D007781:Lactoferrin